Sensors in shoe braces: How doctors plan to monitor treatment of club feet

Its treatment often involves making a child wear a cast for a month to correct deformity, following which, he or she has to wear specially designed shoe-braces for a few years. (Representational Image)

Paediatric orthopaedic surgeon Dr Alaric Aroojis faced a persistent problem. Despite being provided with the best treatment, children with club feet would often suffer a relapse. In 2015, armed with a Google grant, he approached the Stanford University in the US. With no results, in 2016, he presented his problem to the newly launched incubation centre at the Indian Institute of Technology (IIT), Bombay.

Following this, what a group of mechanical, electrical and software engineers, along with a team of doctors, devised is now part of a study that would in the long run help the medical fraternity eradicate club feet.

As doctors remained puzzled over casts and braces being ineffective on their patients, they realised that the children took them off citing various reasons. To tackle this, they took the problem to IIT’s Biomedical Engineering and Technology Innovation Centre (BETIC).

Professor B Ravi, the founder of BETIC, said they brainstormed for weeks before coming up with a design to fit sensors in shoe-braces to record how long a child wore them. “The data recorded by sensor is directly fed on a chip, which a doctor can read. It took us three months to create the first prototype.”

Club foot is a birth defect — with an incidence of one in 800 births — in which a child’s feet are out of shape or twisted. Its treatment often involves making a child wear a cast for a month to correct deformity, following which, he or she has to wear specially designed shoe-braces for a few years.

“This ensures the muscles do not pull the foot back into the clubbed position,” said Aroojis.

The braces are worn for 23 hours each day for three months followed by night-time wear till the child is aged five. “But parents often do not stringently follow. The relapse rate is about 30 per cent globally.”

Five-year-old Yash Pandey has experienced a relapse of club feet twice already. Born at Azamgarh in Uttar Pradesh, he was first fitted with braces when he was one month old. “After eight months, I stopped the braces. There were family problems,” mother Anjali Pandey said.

Yash’s feet became deformed again within six months. When he was two, doctors in Varanasi restarted treatment, fitting him with a plaster and then making him wear braces. For the second time, he stopped wearing the braces within a year. In 2016, the Pandeys shifted to Mumbai for his treatment.

On Monday, at Bai Jerbai Wadia Hospital in Parel, doctors put a fresh plaster to correct Yash’s deformity. In the hospital’s club feet clinic that receives 30 children every month, parents sat with newborns, their legs fitted with plasters. “Yash will have to wear braces for really long since the deformity has grown old,” said Dr Saurabh Sinha, a clinical investigator.

Dr Rujuta Mehta, head of paediatric orthopaedic department at the hospital, said that while parents are counseled to make their baby wear braces for 23 hours each day for three months, they often fail to comply.

“In follow-ups, parents tell us the child wore braces as advised but the relapses indicate otherwise. We realised we need to scientifically study this,” Mehta said. In the clinic, a month-old baby’s leg was being fitted with plaster. Aunt Vaishali Pandey from Malad said she removed the old plaster two days ago. “He was getting itchy.””Whatever correction we did last month has gone to waste. Treatment will have to start afresh,” a counsellor said.

“In this model, data will help doctor understand how to counsel a parent. We hope compliance will improve,” said Professor Ravi.

The incubation centre allows doctors to present medical problems and uses engineering to create various medical devices. Since 2008, when Ravi unofficially began helping doctors, 400 doctors have reached out to him. His team has created 16 patents in medical devices. The 10 centres of BETIC, including the first launched in the IIT-Bombay campus, has 40 mechanical, electrical, and software engineers. It also routinely consults with 50 doctors.

Funded by MiracleFeet, so far 70 children in Wadia hospital have become part of a prospective study to see this prototype’s impact. “We have asked parents to tell us how long a child wears a brace, and we will study the data captured by sensors. Initial analysis shows that parents claim the child is wearing it for long time, but sensors have shown otherwise,” surgeon Aroojis said.

“Often babies cry if braces are uncomfortable, sometimes parents feel shy to go for social events with braces put onto their children. Each child in this study will be analysed as to why the braces are worn for less duration,” he added. BITEC has roped in Metwiz Materials, a creation of IIT alumni, to manufacture the braces and sensor material.